20050430.pdfa
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IDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEiNAME OF BUSINESS
MAILING ADDRESS
CITY ZIP TELEPHONE
NAME
ADDR
ADDRESS 41
CITY ZIP TELEPHONE
7
STATE LICENSE NUMBER
EXPIRATION DATE
CHECKE
114, If 7 _/� - /, J—
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PROPERTY TAX ACCOUNT PARCEL NO.
/_ 56
NEW
RESIDENTIAL
PLUMBING i MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
F OF USE
MIXED USE
CHANGE
]��rREMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FENCE
EJ (
DEMOLISH
TANK
OTHER
GARAGE
RETAINING WALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) E PLAIN.
G/'m VVL"
or
NUMBER NUMBER OF
OF DWEL , LINGA,
STORIES UNITS .
DESCRIBE WORK TO BE DONE
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PLAN CHECK NO:
VESTED DATE
PERMIT
NUMBER to;>
JOB
ADDRESS
PLAT NAME�SUBDIVISION NO
PERMIT EXPIRES
now�
5- __0 4i�
LOT NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING PROPOSED
REQUIRED DEDICATION FT
METER SIZE I LINE SIZE NO. OF FIXTURES
SUITEIAPT9
LID NO
LID FEE S
T ESCP Approved
[3
RW Permil Required
Select Use Permit Required
Inspection Required
13
Sidewalk Required
13
Underground
C3
Wamn rpawfed
13
PRV REQUIRED
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY
DATE
FIRE REVIEWED BY GAS INPE TEST MUST BE DATE
VARIANCE OR CU
A
SEPA
COMPLETED EXEMPT
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OWED PROPOSED
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LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT
SIDE REAR
FRONT URSIDE REAR
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PLANNING REVIEWED BY DATE
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REQ'D , PROVIDED
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FT.) I REMARKS
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND ST TE LAWS REGULATING CONSTRUC-
TION: AND IN DOING THE WORK AUTHORIZED THE Y. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOf3,.CGDL-OF THE V PATEE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSAIW,?_�ANCE ANVCW 18:27.
DATE SIGNED
SPECIAL INSPECTION
REQUIRED 13YES
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recordina Fee
CALL
FOR INSPECTION
(425)
771-0220
OCCUPANT
LOAD
FEE Description FEE
State Surcharge
City Surcharge
Base Fee C6
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL'
This application is not a permit until signed by the
Building official or his/hor Deputy and Fees are paid, and
receipt is acknowledged in space provided
I N it
FIC AL SIG Al NRE DATE
I
L7-VSED B DATE
ATTENTI�M tA L I j1jj
IT IS UNLAWf UL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL/fNSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1109 / IBC110 / IRC110.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS I . . ....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .......
Rough -In ...................
Commercial Final ......
HEATING:
GasTest ....................
Gas Piping .................
Equipment.................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..................
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